Like any 11-year-old boy, Jason DeMarco is not one to ramble on about his day.

Life happens, and he moves on. But he’s quick to point out specifics on the moment he was knocked into the boards during a hockey game between his Vancouver Spirit Peewee team and the Cloverdale Comets.

The incident involved Jason in the starring role: in control of the puck, an opponent chasing him behind the net and another, bigger boy bearing down in front.

Then, a shoulder to Jason’s head, and Jason’s head rammed into the boards behind.

As he tells it, what happened next was anticlimactic. "I just got up and skated to the bench." Not really.

Jason got up and skated down the centre of the ice, obviously disoriented, says his father, Dion DeMarco. From the bench, Jason’s coaches and his father yelled at the boy to turn around and join them. There he sat with a headache throughout the game.

The next day, a doctor confirmed the DeMarcos’ fear. He’d suffered a concussion, his second in the last six months.

He has spent the next 16 days waking up with a throbbing headache.

"It’s hard to see him suffer," says Dion.

"(While he’s recovering) he can’t play any sports or elevate his heart rate. He loves sports, and it’s all been taken away from him. You can see how it’s affecting his childhood."

With a careful recovery under the watch of his father, Jason is less likely to suffer the effect of multiple concussions, or Second Impact Syndrome (SIS), a growing concern among professionals in pediatric brain trauma. In SIS, a brain that hasn’t recovered from a previous concussion swells rapidly minutes or even days after the second blow. With the swelling comes a loss of control over cerebral blood flow, causing cerebral edema, ending in either disability or death.

Jason is part of a growing number of children in B.C. reporting multiple concussions. Since they’re grossly under-reported, it’s nearly impossible to track them, says Dr. Ash Singhal, a neurosurgeon, University of B.C. pediatrics associate professor and the medical director of the pediatric trauma pro-gram at BC Children's Hospital.

Singhal says a concussion diagnosis doesn’t always lead to a visit to the emergency room.

In 2009, the most recent data avail-able, BC Children’s Hospital reported 257 emergency department visits related to concussions in children and youth.

Health care professionals believe those numbers have gone up in the last couple of years because doctors seem to be more willing to diagnose concussions where they would have previously diagnosed them as minor head injuries, according to Mariana Brussoni, director of BC Children’s Hospital’s Injury Reporting and Prevention Program.

The Canadian Paediatric Society released a new position statement in January warning that parents, doctors and coaches need to treat concussions as brain injuries with potentially catastrophic consequences.

"Because their brains are still developing, children and adolescents are more vulnerable to head injury and take longer to recover from concussions than adults," said Dr. Laura Purcell, the CPS statement’s author.

According to a 2006 report in the BC Medical Journal, concussions among players allowed to bodycheck make up 86 per cent of injuries among players age 9 to 15 — an age range when the immature brain may be more vulnerable to injury.

Keith Primeau is a Canadian hockey player who retired in 2006 from a National Hockey League career with the Detroit Red Wings and Philadelphia Flyers.

Though Primeau is six years removed from the four concussive hits that ended his career, he still feels the lingering effect of post-concussion syndrome: headaches, fatigue, neck stiffness and light-headedness during exercise.

The four concussions are only those that have been diagnosed. "I would guess that over my career span I have had around 10," Primeau says from his Philadelphia home.

He keeps busy with various hockey franchises in Ontario and Philadelphia, as a coach of his two sons’ hockey teams, and raising concussion awareness as part of his advocacy group, StopConcussions.com.

Speaking as a coach and father, Primeau says he’s worried about the pressure young hockey players face to return to the ice before they’ve been monitored after a hit.

"These kids aren’t going to understand the severity of their injuries. Even though they may not feel well, they don’t understand, so it disturbs me when I see players returning to the ice before being evaluated," he says.

Generally, players at 10 and 11 years of age aren’t eager to express any concussive pain around their peers, says Primeau. Also, parents could pay in the thousands in registration fees, gear costs and tournaments. Ice time on public rinks is rare and never guaranteed, he adds, so young players and their paying parents could feel the pressure to get as much ice time as possible, without recognizing if a concussed child has fully recovered.

Primeau sees it often. "There’s a lot of external forces at work, economic forces, and there are egos involved. I’ve seen kids who have been two or three concussions along, and they’re in dangerous waters."

Concussions can be caused by a direct blow to the head, neck or face.

Though the jarring impact may not result in a blackout, the victim is knocked out, feels dizzy, has visual disturbances, loss of consciousness or balance, vomiting, irritability, trouble falling asleep or sleeping more than usual. A rare complication is fatal swelling of the brain known as malignant brain edema syndrome: a phenomenon that occurs almost exclusively in children and teens and can lead to coma and death.

Children most often recover from a concussion within three weeks without lingering effects, says Singhal, a neurosurgeon who specializes in operating on brain trauma, tumours and epilepsy.

While specialists with Vancouver’s pediatric trauma program see mostly preteen and adolescent boys, they’re also noticing more girls concussed from injuries on the soccer pitch or through bicycle accidents. Singhal says he’s seeing more multiple concussions in boys aged 10 and older, those he characterizes as the high-energy risk takers. One of his worst cases has been a teenager who had suffered six concussions.

He says cases like Jason DeMarco’s are typical: a young person who suffers a concussion is more likely to suffer another. Though Jason’s recovery is well monitored, too often specialists see damage caused when the child hasn’t received proper treatment after a blow to the head. The child may say he is feeling fine, but then return to the ice, field or pitch before fully recovering.

Even those who’ve suffered one or two concussions in preteen and adolescent years can show a disturbing change in behaviour, he says.

"We’ve seen kids who’ve had concussions, but not a brain injury where blood clots have collected, and they’ve changed their behaviour," says Singhal. "Parents will tell us, ’He was good at school, but now he’s withdrawn, he’s irritable. He gets into fights.’ "

Often, parents mistake such behaviour as a trope of adolescence, a dangerous assumption after a hit to the head, he adds. "It does seem clear that repeated concussions can influence patient mood and behaviour."

Multiple hits over time can lead to extremes, says Chris Nowinski, head of the Boston-based Sports Legacy Institute, a collaboration of doctors and advocates for research on brain trauma linked to contact sports.

According to Nowinski, researchers at the Boston University Center for the Study of Traumatic Encephalopathy recently discovered the youngest documented case of CTE, a degenerative disease found in people who have suffered multiple concussions, in Nathan Stiles, a 17-year-old high school football player who died on the field in October 2010.

West Coast hockey organizations have recently responded to a growing concern over players’ brain trauma with new safety regulations and policies to ban bodychecking in the Pee-wee age group (ages 11 and 12).

The Pacific Coast Amateur Hockey Association voted in a special meeting last month to ban bodychecking in the lower Peewee levels, and vowed to support a motion that BC Hockey follow suit in its general meeting in June. That move would hold all players and coaches across the province to the same standard.

The new rules, which take effect at the start of the 2012-13 season, apply to nearly 20,000 children involved in minor hockey in the Lower Mainland.

Mischa Polzin, a coach and hockey director of the Vancouver Minor Hockey Association, says if bodychecking is done right, it shouldn’t result in injury. But he says he’s seen a deteriorating ethic among young players over the course of his 15-year coaching career.

"Kids are becoming bigger and faster, and many are growing faster than others," says Polzin. "There’s less respect on the ice."

Though the PCAHA’s new policies will have an impact, little will change without more brain-injury education and resources for coaches, volunteers and parents, says Polzin, who’s currently coaching two players who’ve suffered concussions. His recovery policy: a wait of one week without a single headache, then another three-week pause, which could include light training before a return to play. "And they’re not playing without a note from a specialist."

The North Vancouver Minor Hockey Association distributes concussion identification cards to parents, says vice-president Lawrence Smyth. The NVMHA mandates a policy to pull a player if coaches suspect a concussion. They’re not allowed to return to the ice before an "observation skate" and a doctor’s sign-off.

Brandon Campos, a Port Coquitlam native and a forward with Texas’s Rio Grande Valley Killer Bees, is taking a careful, measured approach to his own recovery. Just last month, he concussed for a third time in his career after he fell backward when an opponent tripped him in a game.

"I felt dizzy and sick; I wasn’t unconscious, but I knew what was wrong," he says.

It was a familiar feeling. He had concussed in B.C. games twice before, at ages 12 and 17 — blows that forced him out for weeks at a time.

Though he’s patient with his slow recovery this time, and he’s being supervised by two team doctors, he says the pressure to recover quickly and get back into play is ever present.

"I believe playing professional hockey, there is a certain amount of pressure, because there’s someone coming up after me, ready to fill my job," he says.

"Back in the day I would have pressured myself into playing because there were always scouts watching. In that way, it’s really hard for the younger crew. But now at my age, I’m doing it as a career, so I think, ’Is an extra week on the ice really going to benefit me?’ "

Dion DeMarco says one more concussion would force him to end his son’s hockey-playing.

"I think if Jason had another concussion in the next year or so, I wouldn’t want him to play hockey again. Why would you? As much as they like it, it’s way too risky."

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